Emergency Department Charges for Evaluating Minimally Injured Alcohol-Impaired Drivers
Presented at the SAEM National Conference, May 2007, Washington, DC.
Received 25 November 2008; received in revised form 3 February 2009, 8 March 2009 and 30 April 2009; accepted 12 May 2009. published online 06 July 2009.
Refers to article:
Minor Injury, Major Expense: The Burden of Preinjury Alcohol Intake on Emergency Department Assessment
, 25 August 2009
Jana B.A. MacLeod
Annals of Emergency Medicine
October 2009 (Vol. 54, Issue 4, Pages 600-602) Full Text |
Full-Text PDF (123 KB)
Study objective
The literature on the costs of treating alcohol-impaired motor vehicle crash victims is largely based on inpatient data. Less is known about the more frequent emergency department (ED) evaluations for those who are discharged home. Our objective is to measure the difference in charges and length of stay between alcohol-impaired and nonimpaired drivers in this population.
Methods
This was a retrospective study of charts and billing data for all drivers in motor vehicle crashes, aged 21 to 65 years, treated at an urban Level I trauma center in 2005 and discharged home from the ED. Patients were divided into alcohol-positive and -negative groups according to alcohol level, documentation of recent alcohol use, or clinical intoxication. Itemized charges were tabulated and compared across groups.
Results
Of 1,618 eligible patients, median charges were higher for alcohol-positive patients by $4,538 (95% confidence interval [CI] $2,755 to $5,665). Imaging was 69% of the charge differential because of a higher frequency of imaging (91% versus 70%) and more expensive studies (median difference $2,464; 95% CI $1,507 to $3,400) for alcohol-positive patients. Median length of stay was higher for alcohol-positive patients by 3.3 hours (95% CI 2.7 to 4.1 hours). When stratified by trauma-protocoled triage destination, median charges were higher for alcohol-positive versus -negative patients in non–critical care beds by $2,229 (95% CI $1,039 to $2,693). For patients triaged to critical care beds, the difference in charges was only $132 (95% CI –$1,677 to $1,233).
Conclusion
The presence of alcohol substantially increased charges and length of stay for ED evaluations of injured drivers discharged home, especially for patients who were triaged to non-critical care beds. The magnitudes are striking for this minimally injured population and represent an underreported burden of alcohol-impaired driving.
aDepartments of Emergency Medicine and Community Health, Alpert Medical School of Brown University, Injury Prevention Center at Rhode Island Hospital, Providence, RI
Address for correspondence: Michael H. Lee, MD, MS, Department of Emergency Medicine, Alpert School of Medicine of Brown University, 593 Eddy St, Claverick 274, Providence, RI 02906; 401-444-6489, Fax 877-561-6291
Supervising editors: Debra E. Houry, MD, MPH; David L. Schriger, MD, MPH
Author contributions: MHL and MJM conceived this study. MHL and MJM obtained institutional review board approval for this study. SR supervised data collection and MHL conducted chart review. SR conducted all data analysis and provided statistical and technical advice. MHL drafted the article, and all authors contributed substantially to its revision. MHL takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.
ABSTRACT